| NPI | 1568956894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY P08881) |
| Additional Taxonomies | 103TC2200X Psychologist Clinical Child & Adolescent |
| 103TS0200X Psychologist School | |
| Enumeration Date | 2018-06-20 |
| Last Update Date | 2018-06-20 |