| NPI | 1750817086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 023936) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: NY 2591871) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-05-05 |
| Last Update Date | 2020-10-13 |