| NPI | 1346770179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 022172) |
| Additional Taxonomies | 103T00000X Psychologist |
| 363AM0700X Physician Assistant, Medical (Licence: NY 22172) | |
| Enumeration Date | 2017-06-14 |
| Last Update Date | 2023-07-07 |