| NPI | 1760433825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AZ 4276) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 016467-1) |
| Enumeration Date | 2006-05-13 |
| Last Update Date | 2023-07-11 |