| NPI | 1427339332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 019078) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MA 9389) |
| Enumeration Date | 2011-09-06 |
| Last Update Date | 2013-05-29 |