NPI | 1508236498 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 020829) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NV PY-0907) |
Enumeration Date | 2015-10-05 |
Last Update Date | 2021-08-20 |