NPI | 1467579730 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: NY 018405) |
Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: NE 667) |
Enumeration Date | 2007-03-23 |
Last Update Date | 2018-07-25 |