| NPI | 1194807446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 010210-1) |
| Additional Taxonomies | 103TS0200X Psychologist, School |
| 103TS0200X Psychologist, School | |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2007-07-26 |