| NPI | 1982852570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 018910-1) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CT 8.003101) |
| Enumeration Date | 2008-09-08 |
| Last Update Date | 2018-12-24 |