| NPI | 1407882145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 68 019898) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: FL PY6093) |
| Enumeration Date | 2006-06-24 |
| Last Update Date | 2023-02-04 |