| NPI | 1386725323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 006688) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 006688-2) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2019-10-01 |