| NPI | 1447394119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: DC 942) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MD 1413) |
| 103TC0700X Psychologist, Clinical (Licence: NY 5764) | |
| Enumeration Date | 2007-02-16 |
| Last Update Date | 2007-07-08 |