| NPI | 1891979324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: NY 015486) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 015486) |
| Enumeration Date | 2007-12-19 |
| Last Update Date | 2007-12-19 |