NPI | 1568956894 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103T00000X Psychologist (Licence: NY P08881) |
Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent |
103TS0200X Psychologist, School | |
Enumeration Date | 2018-06-20 |
Last Update Date | 2018-06-20 |