| NPI | 1396997516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: NY 014651) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NY 000518) |
| Enumeration Date | 2008-10-21 |
| Last Update Date | 2008-10-21 |