| NPI | 1235432451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NY 017346) |
| Additional Taxonomies | 103TS0200X Psychologist School |
| Enumeration Date | 2010-12-09 |
| Last Update Date | 2010-12-09 |