| NPI | 1205171964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: SC 1402) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 020238) |
| Enumeration Date | 2012-12-06 |
| Last Update Date | 2024-08-01 |