| NPI | 1932905890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 024233) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: AL 1893) |
| Enumeration Date | 2025-02-21 |
| Last Update Date | 2025-03-03 |