| NPI | 1518349695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 021201) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 021201) |
| Enumeration Date | 2015-06-24 |
| Last Update Date | 2021-08-09 |