| NPI | 1497842678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 009620) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 009620-1) |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2024-09-20 |