| NPI | 1639227259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CT 001520) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 007622) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2007-07-08 |