| NPI | 1144660267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NY 020103-1) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 020103-1) |
| 103TS0200X Psychologist, School (Licence: NY 020103-1) | |
| Enumeration Date | 2013-07-03 |
| Last Update Date | 2021-07-19 |