| NPI | 1225552573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY P07164) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 022751-01) |
| Enumeration Date | 2017-07-28 |
| Last Update Date | 2024-07-12 |