| NPI | 1598994535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 0174121) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 017412-1) |
| 103TC0700X Psychologist, Clinical (Licence: NY 174121) | |
| Enumeration Date | 2009-07-13 |
| Last Update Date | 2023-07-05 |