| NPI | 1801106562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NY 018707-1) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: NY 108707-1) |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: NY 108707-1) | |
| 103TF0000X Psychologist Family (Licence: NY 108707-1) | |
| Enumeration Date | 2010-10-15 |
| Last Update Date | 2010-10-15 |