| NPI | 1902157761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: FL PY8488) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 004633) |
| Enumeration Date | 2012-09-19 |
| Last Update Date | 2024-08-10 |