| NPI | 1205806981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NY 8629) |
| Additional Taxonomies | 103TS0200X Psychologist School (Licence: NY 8629) |
| 103T00000X Psychologist (Licence: NY 8629) | |
| 103TA0400X Psychologist Addiction (Substance Use Disorder) (Licence: NY 8629) | |
| 103TA0700X Psychologist Adult Development & Aging (Licence: NY 8629) | |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: NY 8629) | |
| 103TC0700X Psychologist Clinical (Licence: NY 008629) | |
| 103TC0700X Psychologist Clinical (Licence: NC PP6551) | |
| 103TC0700X Psychologist Clinical (Licence: FL TPPY2772) | |
| 103TC1900X Psychologist Counseling (Licence: NY 8629) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: NY 8629) | |
| 103TF0000X Psychologist Family (Licence: NY 8629) | |
| 103TH0100X Psychologist Health Service (Licence: NY 8629) | |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2024-08-21 |