| NPI | 1851468896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: NY 05666) |
| Additional Taxonomies | 103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: NY 05666) |
| 103TS0200X Psychologist School | |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2007-07-26 |