| NPI | 1881835312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: SC 1792) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 017981) |
| Enumeration Date | 2009-03-12 |
| Last Update Date | 2023-03-02 |