| NPI | 1235163130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 011141) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: NY 011141) |
| 103TC0700X Psychologist, Clinical (Licence: NY 011141) | |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: NY 011141) | |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2013-12-20 |