| NPI | 1245327220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CT 001533) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 007754) |
| Enumeration Date | 2006-10-09 |
| Last Update Date | 2011-06-23 |