| NPI | 1063708188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 025249) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NJ 35SI00701400) |
| 103TC0700X Psychologist, Clinical (Licence: TX 37386) | |
| Enumeration Date | 2011-06-27 |
| Last Update Date | 2023-08-03 |