| NPI | 1194899922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 9812) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CT 1522) |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2012-03-06 |