| NPI | 1669417390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 005261-1) |
| Additional Taxonomies | 103TF0200X Psychologist, Forensic (Licence: NY 005261-1) |
| Enumeration Date | 2006-06-17 |
| Last Update Date | 2010-10-04 |