| NPI | 1477766863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 021956-1) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 021956) |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2021-06-03 |