| NPI | 1992322960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 024706) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: PA PS020493) |
| Enumeration Date | 2020-06-25 |
| Last Update Date | 2025-12-02 |