NPI | 1811984107 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: NY 010122-1) |
Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: NY 010122-2) |
Enumeration Date | 2005-10-01 |
Last Update Date | 2016-12-05 |