| NPI | 1538392154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 018863) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 18863) |
| Enumeration Date | 2009-08-30 |
| Last Update Date | 2023-06-29 |