| NPI | 1306564919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 025153) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MA PSY10000633) |
| Enumeration Date | 2022-08-19 |
| Last Update Date | 2025-04-01 |