| NPI | 1598793184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NY 005396) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: NC 4588) |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2016-09-07 |