| NPI | 1396777454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NY 06772) |
| Additional Taxonomies | 103TH0100X Psychologist Health Service (Licence: NY 06772) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2007-07-08 |