| NPI | 1851414718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MD 03221) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: NY 011530) |
| Enumeration Date | 2007-04-07 |
| Last Update Date | 2007-07-08 |