| NPI | 1144821497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 024066) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 000000) |
| Enumeration Date | 2020-11-03 |
| Last Update Date | 2020-12-09 |