| NPI | 1326192956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 006462) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 006462) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2007-08-07 |