| NPI | 1295989317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 017567) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 017567) |
| 103TR0400X Psychologist, Rehabilitation (Licence: NY 017567) | |
| Enumeration Date | 2008-11-17 |
| Last Update Date | 2024-03-20 |