| NPI | 1144737289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 0115991) |
| Additional Taxonomies | 103TP0814X Psychologist Psychoanalysis |
| 103TC2200X Psychologist Clinical Child & Adolescent | |
| Enumeration Date | 2018-01-10 |
| Last Update Date | 2018-01-10 |