| NPI | 1922368844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 019522-1) |
| Additional Taxonomies | 103TS0200X Psychologist School (Licence: NY 019522-1) |
| Enumeration Date | 2012-05-24 |
| Last Update Date | 2018-11-30 |