| NPI | 1659038941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 024644) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NY 024644) |
| Enumeration Date | 2021-11-21 |
| Last Update Date | 2022-07-25 |