| NPI | 1790267516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 025673) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MA 11426) |
| Enumeration Date | 2018-08-29 |
| Last Update Date | 2026-01-26 |