| NPI | 1235415811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 017860) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 017860) |
| 103TF0200X Psychologist, Forensic (Licence: NY 017860) | |
| Enumeration Date | 2011-10-27 |
| Last Update Date | 2011-10-27 |