| NPI | 1861760357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: NY 016836-1) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 016836-1) |
| Enumeration Date | 2011-12-12 |
| Last Update Date | 2011-12-12 |