| NPI | 1508259326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NV PY0846) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 020759) |
| Enumeration Date | 2015-03-18 |
| Last Update Date | 2020-12-10 |