| NPI | 1396413928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810009249) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 024500) |
| 103T00000X Psychologist | |
| Enumeration Date | 2021-08-30 |
| Last Update Date | 2026-04-23 |