NPI | 1912976747 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: NY 0-1555) |
Additional Taxonomies | 103T00000X Psychologist (Licence: NY 0-15555) |
Enumeration Date | 2006-03-15 |
Last Update Date | 2011-04-06 |