| NPI | 1568498798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: PA PS019642) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 014710) |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2022-10-18 |