| NPI | 1205086873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 010329-1) |
| Additional Taxonomies | 103TF0000X Psychologist, Family (Licence: NY 010329-1) |
| Enumeration Date | 2008-09-19 |
| Last Update Date | 2008-09-19 |