| NPI | 1295994135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 026629) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MO 2008014044) |
| 103TC1900X Psychologist, Counseling (Licence: NY 026629) | |
| 103TH0100X Psychologist, Health Service (Licence: MO 2008014044) | |
| Enumeration Date | 2008-06-05 |
| Last Update Date | 2025-08-29 |