| NPI | 1265989628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 021761) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: NY 021761) |
| 103TH0004X Psychologist, Health (Licence: NY 021761) | |
| Enumeration Date | 2016-09-02 |
| Last Update Date | 2016-09-02 |