| NPI | 1972090678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MA 11681) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 023817) |
| Enumeration Date | 2018-04-18 |
| Last Update Date | 2021-12-23 |