| NPI | 1225788110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NC 103514) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 025188) |
| 103TS0200X Psychologist, School | |
| Enumeration Date | 2022-03-24 |
| Last Update Date | 2023-02-15 |