| NPI | 1316928245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NY 011033) |
| Additional Taxonomies | 103TA0400X Psychologist Addiction (Substance Use Disorder) (Licence: NY 011033) |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: NY 011033) | |
| 103TF0000X Psychologist Family (Licence: NY 011033) | |
| Enumeration Date | 2005-11-08 |
| Last Update Date | 2011-09-23 |