| NPI | 1891285177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 023917) |
| Additional Taxonomies | 103TS0200X Psychologist, School |
| Enumeration Date | 2018-05-13 |
| Last Update Date | 2021-01-04 |