| NPI | 1417575754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: NY 009283-01) |
| Additional Taxonomies | 103TH0004X Psychologist, Health (Licence: NY 009283-01) |
| Enumeration Date | 2020-07-13 |
| Last Update Date | 2020-07-13 |