| NPI | 1841496270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NY 9479) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 9479) |
| Enumeration Date | 2007-06-22 |
| Last Update Date | 2010-12-23 |