| NPI | 1144490731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 8117-1) |
| Additional Taxonomies | 103TF0200X Psychologist, Forensic (Licence: NY 8771-1) |
| Enumeration Date | 2008-03-10 |
| Last Update Date | 2019-11-15 |