| NPI | 1508235672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 021971) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY P99473) |
| Enumeration Date | 2015-09-18 |
| Last Update Date | 2021-11-05 |