| NPI | 1275154577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 025791) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MD 07423) |
| Enumeration Date | 2020-04-28 |
| Last Update Date | 2025-07-07 |