NPI | 1770691420 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103T00000X Psychologist (Licence: NY 012082) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 012082) |
103TP2701X Psychologist, Group Psychotherapy (Licence: NY 012082) | |
103TF0000X Psychologist, Family (Licence: NY 012082) | |
Enumeration Date | 2006-08-25 |
Last Update Date | 2007-07-08 |