| NPI | 1710391560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 027496) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: NY 027496) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NY 027496) | |
| Enumeration Date | 2014-06-19 |
| Last Update Date | 2025-09-23 |