Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | P98196 | NY |
NPI | 1043696362 |
---|---|
Provider Name | Dr. Andrew Nelson |
First Address | Getzville, NY 14068-1231 |
Second Address | Getzville, NY 14068-1231 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2015 |
Last Update Date | 10/08/2015 |