| NPI | 1336404797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 022642) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: IL 071008499) |
| 103T00000X Psychologist (Licence: IN 20042444A) | |
| Enumeration Date | 2012-07-11 |
| Last Update Date | 2024-10-01 |