| NPI | 1629069711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 006704-1) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CT 002093) |
| Enumeration Date | 2005-10-29 |
| Last Update Date | 2011-01-27 |