| NPI | 1346537040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CT 3694) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 021284) |
| 103TC0700X Psychologist Clinical (Licence: NY 021284) | |
| Enumeration Date | 2011-07-01 |
| Last Update Date | 2022-02-06 |