| NPI | 1952133084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 026631) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CT 5118) |
| Enumeration Date | 2024-08-16 |
| Last Update Date | 2025-07-01 |