| NPI | 1154560357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NH 1227) |
| Additional Taxonomies | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: NY 017813-1) |
| Enumeration Date | 2009-02-11 |
| Last Update Date | 2017-02-03 |