| NPI | 1265639926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TS0200X Psychologist School |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: NY 010998) |
| 103T00000X Psychologist (Licence: NY 010998) | |
| 103TA0400X Psychologist Addiction (Substance Use Disorder) (Licence: NY 010998) | |
| 103TF0200X Psychologist Forensic (Licence: NY 010998) | |
| Enumeration Date | 2007-06-27 |
| Last Update Date | 2022-07-21 |