| NPI | 1912976747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 0-1555) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 0-15555) |
| Enumeration Date | 2006-03-15 |
| Last Update Date | 2011-04-06 |