| NPI | 1497917330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810007343) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 018073) |
| Enumeration Date | 2008-07-01 |
| Last Update Date | 2025-07-29 |