| NPI | 1952443962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810003396) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 015967-1) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2010-01-14 |