| NPI | 1174189377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 014233-1) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 014233-1) |
| Enumeration Date | 2019-05-13 |
| Last Update Date | 2020-07-11 |