| NPI | 1306394184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 023871) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 023871) |
| 103TH0100X Psychologist, Health Service (Licence: NY 023871) | |
| Enumeration Date | 2016-09-21 |
| Last Update Date | 2021-12-09 |