| NPI | 1477106045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY12629) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 027721) |
| Enumeration Date | 2019-07-22 |
| Last Update Date | 2025-12-09 |