| NPI | 1750965547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CT 4981) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 026808) |
| Enumeration Date | 2021-05-08 |
| Last Update Date | 2025-07-16 |