| NPI | 1548825078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 024880-01) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 24880) |
| Enumeration Date | 2019-05-09 |
| Last Update Date | 2025-03-21 |