| NPI | 1518593722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VT 048.0057939) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 023411) |
| Enumeration Date | 2020-03-19 |
| Last Update Date | 2023-11-27 |