| NPI | 1104949924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NC 4483) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 015843) |
| Enumeration Date | 2007-04-08 |
| Last Update Date | 2022-07-21 |