| NPI | 1073255766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 025209) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MN LP6842) |
| Enumeration Date | 2022-04-12 |
| Last Update Date | 2022-10-17 |