| NPI | 1477691384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 015938) |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral (Licence: NY 015938) |
| 103TC0700X Psychologist Clinical (Licence: NY 015938) | |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2007-07-08 |