NPI | 1497960694 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: NY 005951) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 005951) |
103TH0004X Psychologist, Health (Licence: NY 005951) | |
Enumeration Date | 2007-05-11 |
Last Update Date | 2007-07-08 |