| NPI | 1104832781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NY 014548) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: NY 14548) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2014-01-07 |