| NPI | 1346402765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NY 009577) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: MA 7378) |
| Enumeration Date | 2008-06-26 |
| Last Update Date | 2008-06-26 |