| NPI | 1700865953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 011078) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 011078) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NY 011078) | |
| Enumeration Date | 2006-01-14 |
| Last Update Date | 2025-01-24 |