| NPI | 1467579730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TB0200X Psychologist Cognitive & Behavioral (Licence: NY 018405) |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral (Licence: NE 667) |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2018-07-25 |