| NPI | 1851468896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TS0200X Psychologist, School |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NY 05666) |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: NY 05666) | |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2025-09-11 |