| NPI | 1215308929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CO PSY.0004937) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: NY 2557050) |
| 103TC0700X Psychologist, Clinical (Licence: IL 071.009121) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: IL 071.009121) | |
| Enumeration Date | 2015-10-08 |
| Last Update Date | 2026-02-03 |