| NPI | 1063733533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 7980-1) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: FL PY5388) |
| 103T00000X Psychologist (Licence: SD 400) | |
| Enumeration Date | 2010-06-18 |
| Last Update Date | 2010-06-18 |