| NPI | 1396201661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 023181) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY27964) |
| Enumeration Date | 2019-02-12 |
| Last Update Date | 2019-04-09 |