| NPI | 1588088686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 021966) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CT 3516) |
| Enumeration Date | 2014-02-10 |
| Last Update Date | 2017-01-23 |