| NPI | 1154336014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 010667) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 010667) |
| 103TH0100X Psychologist, Health Service (Licence: NY 010667) | |
| Enumeration Date | 2006-07-29 |
| Last Update Date | 2013-05-24 |