| NPI | 1770078214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 024162) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: NY 1233566181) |
| Enumeration Date | 2018-06-27 |
| Last Update Date | 2023-02-14 |