NPI | 1518030774 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 004983-1) |
Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NY 004983-1) |
103T00000X Psychologist (Licence: NY 004983-1) | |
103TP2701X Psychologist, Group Psychotherapy (Licence: NY 004983-1) | |
103T00000X Psychologist | |
Enumeration Date | 2006-11-16 |
Last Update Date | 2007-07-26 |