| NPI | 1922412659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 020642) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: NY 020642) |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: NY 020642) | |
| 103T00000X Psychologist (Licence: NY 020642) | |
| Enumeration Date | 2014-06-20 |
| Last Update Date | 2014-09-23 |