| NPI | 1265452536 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 5388-1) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 005388) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2022-02-15 |