| NPI | 1750844957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 0219248) |
| Additional Taxonomies | 103TS0200X Psychologist, School |
| Enumeration Date | 2019-04-13 |
| Last Update Date | 2019-04-13 |