| NPI | 1831381201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA 9571) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 021028-1) |
| Enumeration Date | 2007-08-09 |
| Last Update Date | 2021-07-21 |