| NPI | 1396220190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NY 027213) |
| Additional Taxonomies | 103TC1900X Psychologist Counseling (Licence: PR 6059) |
| Enumeration Date | 2018-09-27 |
| Last Update Date | 2025-06-09 |