| NPI | 1932816402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 025590-01) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CT 4481) |
| 103TC0700X Psychologist, Clinical (Licence: MD 06770) | |
| Enumeration Date | 2022-11-03 |
| Last Update Date | 2023-11-10 |