| NPI | 1083148001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 022108) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NJ 35SI00588300) |
| 103TC0700X Psychologist, Clinical (Licence: VA 0810007799) | |
| Enumeration Date | 2017-04-17 |
| Last Update Date | 2024-02-19 |