| NPI | 1154130656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 026461) |
| Additional Taxonomies | 103TF0000X Psychologist, Family |
| 103T00000X Psychologist | |
| 103TB0200X Psychologist, Cognitive & Behavioral | |
| 103TC1900X Psychologist, Counseling | |
| 103TC2200X Psychologist, Clinical Child & Adolescent | |
| 103TH0100X Psychologist, Health Service | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities | |
| 103TP2701X Psychologist, Group Psychotherapy | |
| Enumeration Date | 2024-12-31 |
| Last Update Date | 2024-12-31 |