| NPI | 1477390268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: SC 1890) |
| Additional Taxonomies | 103TH0100X Psychologist, Health Service (Licence: NY 025551-01) |
| Enumeration Date | 2024-07-10 |
| Last Update Date | 2026-06-17 |