| NPI | 1790950798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MD 04954) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 017505) |
| Enumeration Date | 2008-04-29 |
| Last Update Date | 2014-04-28 |