| NPI | 1356400386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 011826-1) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: FL PY 7876) |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2009-05-27 |