| NPI | 1720246549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 282479) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NY 02466) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NY 012466) | |
| Enumeration Date | 2008-05-29 |
| Last Update Date | 2023-08-08 |