| NPI | 1982745956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 5453) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 5453) |
| Enumeration Date | 2007-02-10 |
| Last Update Date | 2013-12-31 |