| NPI | 1760065155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 023486) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CO 0005468) |
| Enumeration Date | 2021-05-03 |
| Last Update Date | 2021-05-03 |