| NPI | 1225112071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NY 005196-1) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: NY 005196) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2024-01-16 |