| NPI | 1306982145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 018277) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 171M00000X Case Manager/Care Coordinator | |
| 103TC0700X Psychologist, Clinical (Licence: CA PSY 21685) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CA PSY 21685) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: CA PSY 21685) | |
| 103T00000X Psychologist (Licence: CA PSY 21685) | |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2010-09-03 |