| NPI | 1023123106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 015565) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 015565-1) |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2010-11-24 |