| NPI | 1366729691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 015395-1) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CT 002455) |
| Enumeration Date | 2011-11-15 |
| Last Update Date | 2011-11-15 |