| NPI | 1649443946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 013569) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSY21486) |
| Enumeration Date | 2008-04-08 |
| Last Update Date | 2022-07-21 |