| NPI | 1285151787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 022302) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CT 004028) |
| Enumeration Date | 2017-08-25 |
| Last Update Date | 2022-09-01 |