| NPI | 1568796886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NC 4915) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 017998) |
| 103TC0700X Psychologist Clinical (Licence: NC 4915) | |
| Enumeration Date | 2009-09-21 |
| Last Update Date | 2016-01-12 |