| NPI | 1518177211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 004813-1) |
| Additional Taxonomies | 103TF0200X Psychologist, Forensic (Licence: NY 004813-1) |
| 103TP0814X Psychologist, Psychoanalysis (Licence: NY 004813-1) | |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2017-02-02 |