| NPI | 1740482397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NY 3606) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: MA 8143) |
| Enumeration Date | 2007-06-05 |
| Last Update Date | 2007-07-08 |