| NPI | 1740466895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 021191) |
| Additional Taxonomies | 103TF0200X Psychologist Forensic |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities | |
| Enumeration Date | 2008-01-18 |
| Last Update Date | 2018-08-12 |