NPI | 1265657944 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: NY 008441) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 008441) |
103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NY 008441) | |
103TF0000X Psychologist, Family (Licence: NY 008441) | |
103TP2701X Psychologist, Group Psychotherapy (Licence: NY 008441) | |
Enumeration Date | 2007-04-16 |
Last Update Date | 2007-07-08 |