| NPI | 1255447751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 010630) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NY 010630) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: NY 010630) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: NY 010630) | |
| 103TS0200X Psychologist, School (Licence: NY 010630) | |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2007-07-14 |