| NPI | 1962707240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: FL PY7013) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 006286) |
| Enumeration Date | 2011-01-19 |
| Last Update Date | 2016-06-20 |