| NPI | 1083125165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CT 003698) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 024096) |
| Enumeration Date | 2017-10-17 |
| Last Update Date | 2021-03-22 |