NPI | 1295989317 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 017567) |
Additional Taxonomies | 103T00000X Psychologist (Licence: NY 017567) |
103TR0400X Psychologist, Rehabilitation (Licence: NY 017567) | |
Enumeration Date | 2008-11-17 |
Last Update Date | 2024-07-08 |