| NPI | 1922265404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS016534) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 68 017624) |
| Enumeration Date | 2008-05-21 |
| Last Update Date | 2019-12-12 |