| NPI | 1750679320 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TS0200X Psychologist, School |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: NY 719946) |
| Enumeration Date | 2011-07-18 |
| Last Update Date | 2011-07-18 |