| NPI | 1649323023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TF0000X Psychologist, Family (Licence: NY 013502) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 013502) |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2008-02-26 |