| NPI | 1508236498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 020829) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NV PY-0907) |
| Enumeration Date | 2015-10-05 |
| Last Update Date | 2021-08-20 |