| NPI | 1003215567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 023798) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 023981) |
| Enumeration Date | 2014-08-20 |
| Last Update Date | 2022-06-21 |