| NPI | 1760854665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: CO PSY.0005453) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: NY 023198) |
| Enumeration Date | 2015-10-30 |
| Last Update Date | 2026-04-21 |