| NPI | 1659309136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 009471) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 9471) |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2023-07-05 |