| NPI | 1275641748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 8562) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: NY 008562) |
| 103TC0700X Psychologist, Clinical (Licence: NY 008562) | |
| Enumeration Date | 2006-08-26 |
| Last Update Date | 2025-03-19 |