| NPI | 1497843437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 011909) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: FL 5008) |
| 103TC0700X Psychologist, Clinical (Licence: AZ 1835) | |
| 103TC0700X Psychologist, Clinical (Licence: IL 71004446) | |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2008-06-19 |