| NPI | 1831623255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: NY 988428151) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 2292841) |
| Enumeration Date | 2017-04-12 |
| Last Update Date | 2017-04-12 |