NPI | 1386725323 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: NY 006688) |
Additional Taxonomies | 103T00000X Psychologist (Licence: NY 006688-2) |
Enumeration Date | 2006-10-18 |
Last Update Date | 2019-10-01 |