| NPI | 1912459330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 023382) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY 28765) |
| Enumeration Date | 2016-11-02 |
| Last Update Date | 2020-02-07 |