| NPI | 1144380254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 006099) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 6099) |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2020-03-31 |