| NPI | 1265750087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PR 3606) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY p73117) |
| Enumeration Date | 2010-05-05 |
| Last Update Date | 2010-05-05 |