| NPI | 1861516627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NY 014347) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: NJ 3980) |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2007-07-08 |