| NPI | 1245328046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: FL PY4991) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 011658-1) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2007-07-08 |