| NPI | 1891535514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MA PSY10001063) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 026649) |
| Enumeration Date | 2024-05-30 |
| Last Update Date | 2024-11-06 |