| NPI | 1356536486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 019422) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA 30258) |
| Enumeration Date | 2007-09-11 |
| Last Update Date | 2021-05-25 |