| NPI | 1215225602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 015540-1) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6301014403) |
| 103TC0700X Psychologist, Clinical (Licence: NH 1224) | |
| 103TS0200X Psychologist, School (Licence: NH 82115) | |
| Enumeration Date | 2011-07-19 |
| Last Update Date | 2012-05-01 |