| NPI | 1033173745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 024087) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: PR 2559) |
| Enumeration Date | 2006-04-12 |
| Last Update Date | 2021-12-10 |