| NPI | 1467731471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 009174) |
| Additional Taxonomies | 283X00000X Rehabilitation Hospital (Licence: NY 009174) |
| Enumeration Date | 2011-08-08 |
| Last Update Date | 2011-08-08 |