| NPI | 1689783607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 015629) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CT 002514) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2009-05-19 |