| NPI | 1598711327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 8460) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: FL PY 6058) |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2016-01-14 |