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 |