| NPI | 1194229914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NY 022587-1) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 022587-1) |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: NY 022587-1) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: NY 022587-1) | |
| 103TF0000X Psychologist Family (Licence: NY 022587-1) | |
| Enumeration Date | 2018-03-19 |
| Last Update Date | 2020-05-20 |