| NPI | 1376891937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 021842) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: OH 6940) |
| Enumeration Date | 2012-08-29 |
| Last Update Date | 2016-09-27 |