| NPI | 1265595516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY P54612) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 018394) |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2011-01-02 |