NPI | 1790950798 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103T00000X Psychologist (Licence: MD 04954) |
Additional Taxonomies | 103T00000X Psychologist (Licence: NY 017505) |
Enumeration Date | 2008-04-29 |
Last Update Date | 2014-04-28 |