| NPI | 1376608034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 004496-1) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 4496) |
| 103T00000X Psychologist (Licence: NY 0044961) | |
| 103T00000X Psychologist (Licence: NY 004496-1) | |
| Enumeration Date | 2006-12-23 |
| Last Update Date | 2009-02-23 |