| NPI | 1134202997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AZ 3562) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 015106) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2018-06-08 |