| NPI | 1043827678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 013329) |
| Additional Taxonomies | 103T00000X Psychologist |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NY 013329) | |
| Enumeration Date | 2020-09-28 |
| Last Update Date | 2020-09-28 |