| NPI | 1598155038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 012684) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NH 1079) |
| 103T00000X Psychologist (Licence: CT 001507) | |
| Enumeration Date | 2015-02-04 |
| Last Update Date | 2015-02-04 |