NPI | 1407153471 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY9590) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 019192) |
Enumeration Date | 2011-02-27 |
Last Update Date | 2019-07-20 |