NPI | 1336362516 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NY 68 017699) |
Additional Taxonomies | 103T00000X Psychologist (Licence: GA PSY001800) |
Enumeration Date | 2007-04-10 |
Last Update Date | 2014-04-29 |