| NPI | 1629368550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NY 012769) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 012769) |
| 103TC0700X Psychologist, Clinical (Licence: NY 012769) | |
| Enumeration Date | 2011-04-12 |
| Last Update Date | 2022-11-01 |