| NPI | 1851727606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 020863) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: NY 1284837) |
| Enumeration Date | 2013-09-24 |
| Last Update Date | 2015-10-06 |