| NPI | 1457613572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 024719-01) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: NH 1383) |
| Enumeration Date | 2012-06-14 |
| Last Update Date | 2023-07-06 |