| NPI | 1093114464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 021931) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: TX 40079) |
| 103T00000X Psychologist (Licence: FL TPPY2475) | |
| Enumeration Date | 2014-08-21 |
| Last Update Date | 2023-12-06 |