| NPI | 1366907909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA 022858) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 022858) |
| 103TC0700X Psychologist, Clinical (Licence: NY 022858) | |
| Enumeration Date | 2019-02-07 |
| Last Update Date | 2020-09-14 |