| NPI | 1689916439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 018263) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CT 3206) |
| Enumeration Date | 2013-03-20 |
| Last Update Date | 2021-12-21 |