| NPI | 1538144936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY 7740) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 010826) |
| Enumeration Date | 2005-12-08 |
| Last Update Date | 2014-04-10 |