| NPI | 1720960073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 27412) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: TX 40944) |
| 103TC0700X Psychologist, Clinical (Licence: WI 5452-57) | |
| 103TC0700X Psychologist, Clinical (Licence: DE B1-0011541) | |
| Enumeration Date | 2025-07-25 |
| Last Update Date | 2025-10-21 |