| NPI | 1205001427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 4237) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 4237) |
| Enumeration Date | 2008-04-29 |
| Last Update Date | 2008-04-29 |