| NPI | 1750545331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 022043) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA 26095) |
| Enumeration Date | 2008-07-14 |
| Last Update Date | 2017-05-10 |