| NPI | 1376164012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 026830) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NH 7145) |
| 103T00000X Psychologist (Licence: MA PSY11773) | |
| 103T00000X Psychologist (Licence: CT 004880) | |
| 103T00000X Psychologist (Licence: NJ 35SI00767600) | |
| Enumeration Date | 2020-05-05 |
| Last Update Date | 2026-08-17 |