| NPI | 1992864441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PSY8164) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 007895) |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2010-11-01 |