| NPI | 1942242896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 008545) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 8545) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2012-08-14 |