| NPI | 1275222127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: KY 276794) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 024766) |
| Enumeration Date | 2023-05-05 |
| Last Update Date | 2026-03-18 |