| NPI | 1457695090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 024776) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MA 11326) |
| Enumeration Date | 2012-11-20 |
| Last Update Date | 2022-03-07 |