| NPI | 1790557437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NY 026098) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 026098) |
| 103T00000X Psychologist (Licence: WA PY61659694) | |
| 103TA0700X Psychologist Adult Development & Aging (Licence: NY 026098) | |
| 103TA0700X Psychologist Adult Development & Aging (Licence: WA PY61659694) | |
| 103TC0700X Psychologist Clinical (Licence: WA PY61659694) | |
| Enumeration Date | 2023-10-26 |
| Last Update Date | 2025-03-23 |