| NPI | 1275276719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 027559) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA 36627) |
| 103T00000X Psychologist (Licence: NJ 35SI00815600) | |
| Enumeration Date | 2022-04-13 |
| Last Update Date | 2026-07-08 |