| NPI | 1952883878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS019180) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 022830) |
| Enumeration Date | 2018-09-06 |
| Last Update Date | 2024-03-26 |