| NPI | 1659474237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CT 1917) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 0123001) |
| Enumeration Date | 2006-09-07 |
| Last Update Date | 2026-05-20 |