NPI | 1386707768 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 007029) |
Additional Taxonomies | 103T00000X Psychologist (Licence: CT 001665) |
Enumeration Date | 2006-12-18 |
Last Update Date | 2008-01-02 |