| NPI | 1083372551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY P113412) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 0000000) |
| Enumeration Date | 2021-12-02 |
| Last Update Date | 2022-01-06 |