| NPI | 1871982942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TR0400X Psychologist, Rehabilitation (Licence: CT 002689) |
| Additional Taxonomies | 103TR0400X Psychologist, Rehabilitation (Licence: NY 015371) |
| Enumeration Date | 2015-01-13 |
| Last Update Date | 2016-08-11 |