| NPI | 1154959963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TF0200X Psychologist Forensic (Licence: NY 017817) |
| Additional Taxonomies | 103TA0400X Psychologist Addiction (Substance Use Disorder) (Licence: NY 017817) |
| 103TA0700X Psychologist Adult Development & Aging (Licence: NY 017817) | |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: NY 017817) | |
| 103TC0700X Psychologist Clinical (Licence: NY 017817) | |
| 103TF0000X Psychologist Family (Licence: NY 017817) | |
| 103TP2701X Psychologist Group Psychotherapy (Licence: NY 017817) | |
| Enumeration Date | 2020-03-28 |
| Last Update Date | 2020-03-28 |