| NPI | 1326488941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA 9999) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 68 021044) |
| Enumeration Date | 2013-06-27 |
| Last Update Date | 2015-07-29 |