| NPI | 1164575064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 011086) |
| Additional Taxonomies | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: NH 999) |
| 103TH0100X Psychologist Health Service (Licence: NY 011086) | |
| 103TH0100X Psychologist Health Service (Licence: NH 999) | |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: NH 999) | |
| 103G00000X Clinical Neuropsychologist (Licence: NY 011086) | |
| 103G00000X Clinical Neuropsychologist (Licence: NH 999) | |
| 103T00000X Psychologist (Licence: NH 999) | |
| 103TA0700X Psychologist Adult Development & Aging (Licence: NY 011086) | |
| 103TA0700X Psychologist Adult Development & Aging (Licence: NH 999) | |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: NY 011086) | |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: NH 999) | |
| 103TC0700X Psychologist Clinical (Licence: NY 011086) | |
| 103TC0700X Psychologist Clinical (Licence: NH 999) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: NY 011086) | |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2022-06-24 |