| NPI | 1619042546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CT 1959) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 012263-1) |
| Enumeration Date | 2006-11-24 |
| Last Update Date | 2013-05-23 |