| NPI | 1841312121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TF0200X Psychologist, Forensic |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 011699-1) |
| 103TC2200X Psychologist, Clinical Child & Adolescent | |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2007-08-10 |