| NPI | 1376154583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810007970) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 025256) |
| Enumeration Date | 2020-08-11 |
| Last Update Date | 2025-10-06 |