| NPI | 1982837266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TB0200X Psychologist Cognitive & Behavioral (Licence: NY 009303) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 009303) |
| Enumeration Date | 2009-09-02 |
| Last Update Date | 2009-09-02 |