| NPI | 1831560010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 021363) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: NY 021363) |
| Enumeration Date | 2015-10-13 |
| Last Update Date | 2022-07-11 |