| NPI | 1114245321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MD 04782) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 018426) |
| Enumeration Date | 2010-05-12 |
| Last Update Date | 2010-05-12 |