| NPI | 1518333913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 025233) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA 31909) |
| Enumeration Date | 2015-08-19 |
| Last Update Date | 2024-07-10 |