| NPI | 1114599008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS019275) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 024189-01) |
| Enumeration Date | 2021-07-12 |
| Last Update Date | 2021-07-12 |