NPI | 1548825078 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 024880-01) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 24880) |
Enumeration Date | 2019-05-09 |
Last Update Date | 2025-03-21 |