| NPI | 1093932816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NY 018193) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: NY P68794) |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2023-07-21 |