| NPI | 1619171618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810007761) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 68-019393) |
| Enumeration Date | 2007-06-13 |
| Last Update Date | 2022-02-25 |