| NPI | 1386352581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 025347) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: NY 025347) |
| 103TC0700X Psychologist, Clinical (Licence: NY 025347) | |
| Enumeration Date | 2022-11-08 |
| Last Update Date | 2022-11-08 |