| NPI | 1265813901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CT 4980) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 020331) |
| Enumeration Date | 2015-06-17 |
| Last Update Date | 2025-02-05 |