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 |