| NPI | 1033435201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NY 6780588) |
| Additional Taxonomies | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: NY 6780588) |
| 103TF0000X Psychologist Family (Licence: NY 6780588) | |
| Enumeration Date | 2010-04-13 |
| Last Update Date | 2010-04-13 |