| NPI | 1669623252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS017885) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 019683) |
| Enumeration Date | 2008-10-01 |
| Last Update Date | 2022-06-30 |