| NPI | 1295067304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 018595-1) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY P72029) |
| Enumeration Date | 2010-02-01 |
| Last Update Date | 2010-07-12 |