| NPI | 1720222995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 018657) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NC 3633) |
| Enumeration Date | 2009-05-01 |
| Last Update Date | 2011-01-28 |