| NPI | 1023213006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 017633) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: VA 0810009251) |
| Enumeration Date | 2007-06-19 |
| Last Update Date | 2026-02-12 |