| NPI | 1447248026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NY 009373) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 009373) |
| Enumeration Date | 2005-10-08 |
| Last Update Date | 2011-09-22 |