| NPI | 1164545489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 0113661) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NJ 0215) |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2007-07-08 |