| NPI | 1841340700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 010096-1) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: FL PY5552) |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2026-05-04 |