| NPI | 1649543539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 024369) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: DC PSY1000769) |
| Enumeration Date | 2012-02-23 |
| Last Update Date | 2022-08-31 |