| NPI | 1346639713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MD 05295) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 019927) |
| Enumeration Date | 2015-01-22 |
| Last Update Date | 2022-05-06 |