NPI | 1902058209 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: NY 009774) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 009774) |
103TH0004X Psychologist, Health (Licence: NY 009774) | |
Enumeration Date | 2008-10-17 |
Last Update Date | 2008-10-17 |