| NPI | 1295940096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 6406) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CT 2456) |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2007-07-08 |