| NPI | 1548593544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY P04143) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSB94021854) |
| Enumeration Date | 2009-09-09 |
| Last Update Date | 2016-11-14 |