| NPI | 1215238779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: NY 0204741) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 73 080818) |
| Enumeration Date | 2010-11-15 |
| Last Update Date | 2015-09-03 |