| NPI | 1528392412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 0182951) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 018295) |
| Enumeration Date | 2009-09-24 |
| Last Update Date | 2011-03-29 |