| NPI | 1720455231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 022673) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NC 4939) |
| Enumeration Date | 2015-09-01 |
| Last Update Date | 2018-05-25 |