NPI | 1700944519 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CT 002671) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 016419) |
133V00000X Dietitian, Registered (Licence: NY 006043) | |
133V00000X Dietitian, Registered (Licence: CT 000715) | |
Enumeration Date | 2006-12-05 |
Last Update Date | 2008-06-04 |