| NPI | 1598114589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 023314) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MD 05917) |
| Enumeration Date | 2016-06-09 |
| Last Update Date | 2020-04-13 |