| NPI | 1295733699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 014389) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: NY 014389) |
| Enumeration Date | 2005-07-08 |
| Last Update Date | 2008-06-19 |