| NPI | 1043489339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 017102) |
| Additional Taxonomies | 103T00000X Psychologist |
| 103TC0700X Psychologist, Clinical (Licence: CA 21681) | |
| 103TC0700X Psychologist, Clinical (Licence: MA 8810) | |
| 103TC0700X Psychologist, Clinical (Licence: FL PY9535) | |
| Enumeration Date | 2008-02-21 |
| Last Update Date | 2023-06-13 |