| NPI | 1942504477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TF0200X Psychologist Forensic (Licence: NY 010495) |
| Additional Taxonomies | 103TF0000X Psychologist Family |
| Enumeration Date | 2010-12-23 |
| Last Update Date | 2010-12-23 |