| NPI | 1447866355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 106915-01) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 017776) |
| Enumeration Date | 2020-09-17 |
| Last Update Date | 2020-09-17 |