| NPI | 1225341696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CT 3424) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 019399) |
| Enumeration Date | 2010-07-14 |
| Last Update Date | 2021-02-09 |