| NPI | 1700944519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CT 002671) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 016419) |
| 133V00000X Dietitian, Registered (Licence: NY 006043) | |
| 133V00000X Dietitian, Registered (Licence: CT 000715) | |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2008-06-04 |