| NPI | 1710385943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 021443) |
| Additional Taxonomies | 103T00000X Psychologist |
| 103TF0200X Psychologist, Forensic (Licence: NY 021443) | |
| Enumeration Date | 2014-12-22 |
| Last Update Date | 2021-08-03 |