| NPI | 1972708352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 011519) |
| Additional Taxonomies | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: NY 011519) |
| 103TF0000X Psychologist Family (Licence: NY 011519) | |
| Enumeration Date | 2007-06-18 |
| Last Update Date | 2015-03-20 |