| NPI | 1972809796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 6554) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CT 1044) |
| Enumeration Date | 2011-01-27 |
| Last Update Date | 2011-01-27 |