| NPI | 1790997005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 019088-1) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CT 003095) |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2012-07-13 |