| NPI | 1912941352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 013294) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: AZ PSY-005546) |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2023-02-01 |