| NPI | 1740393735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 011107) |
| 103T00000X Psychologist (Licence: NY 0111107) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NY 011107) | |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2022-07-21 |