| NPI | 1821673328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY12220) |
| Additional Taxonomies | 103T00000X Psychologist |
| 103TC0700X Psychologist, Clinical (Licence: NY 013661) | |
| 103TC0700X Psychologist, Clinical (Licence: NH 1649) | |
| Enumeration Date | 2021-03-16 |
| Last Update Date | 2024-08-23 |