| NPI | 1265943005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: NY 022380) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NY 022380) |
| 103TE1100X Psychologist, Exercise & Sports (Licence: NY 022380) | |
| Enumeration Date | 2017-10-19 |
| Last Update Date | 2019-10-25 |