| NPI | 1902054091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: UT 8651960-2501) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 019911) |
| Enumeration Date | 2008-09-03 |
| Last Update Date | 2014-11-06 |