NPI | 1699899674 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CA 34415) |
Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CA 34415) |
103TB0200X Psychologist, Cognitive & Behavioral (Licence: NY 018596) | |
103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NY 018596) | |
Enumeration Date | 2007-03-16 |
Last Update Date | 2023-11-02 |