| NPI | 1447220090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 5721) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 005721) |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2015-04-16 |