NPI | 1699718874 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | |
Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NY 015313) |
Additional Taxonomies | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: NY 015313) |
Enumeration Date | 2006-06-14 |
Last Update Date | 2007-07-08 |