| NPI | 1558785691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 021694) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MD 05048) |
| Enumeration Date | 2014-02-10 |
| Last Update Date | 2025-08-25 |