| NPI | 1255633921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 013376) |
| Additional Taxonomies | 103TS0200X Psychologist, School |
| Enumeration Date | 2010-12-01 |
| Last Update Date | 2010-12-01 |