| NPI | 1982431706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 027511) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MA PSY10001946) |
| 103TC0700X Psychologist, Clinical (Licence: VT 048.0135374) | |
| Enumeration Date | 2024-09-16 |
| Last Update Date | 2026-08-19 |