| NPI | 1861408445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 8060) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 8060) |
| 103TC1900X Psychologist, Counseling (Licence: NY 8060) | |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2015-03-25 |