Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) |
NPI | 1346512936 |
---|---|
Provider Name | Prof. Daniel Amado Trujillo |
First Address | New York, NY 10032-2652 |
Second Address | New York, NY 10032-2652 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2012 |
Last Update Date | 30/01/2012 |