| NPI | 1609807916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 6046) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CT 669) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2011-08-17 |