Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | NY |
NPI | 1073093019 |
---|---|
Provider Name | Dovid Rudomin |
First Address | Brooklyn, NY 11230-5241 |
Second Address | Brooklyn, NY 11230-5241 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2018 |
Last Update Date | 20/08/2018 |