| NPI | 1194039255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CT 3075) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 018332-1) |
| Enumeration Date | 2010-08-01 |
| Last Update Date | 2015-10-29 |