NPI | 1457491060 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: NY 011698) |
Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: NY 011698) |
103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NY 011698) | |
Enumeration Date | 2007-02-06 |
Last Update Date | 2007-07-08 |