| NPI | 1578892568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NC 5966) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 00074737) |
| 103T00000X Psychologist (Licence: NY 00018932) | |
| Enumeration Date | 2009-12-22 |
| Last Update Date | 2021-10-05 |