NPI | 1407078769 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 009149-1) |
Additional Taxonomies | 103T00000X Psychologist (Licence: NY 009149) |
Enumeration Date | 2007-05-03 |
Last Update Date | 2007-07-08 |