| NPI | 1487666368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OR 1762) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 015427) |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2007-07-12 |