| NPI | 1689707580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 8682) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 008682) |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2019-12-13 |