| NPI | 1336312412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 011404) |
| Additional Taxonomies | 103TA0700X Psychologist, Adult Development & Aging (Licence: NY 011404) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: NY 011404) | |
| 103TF0200X Psychologist, Forensic (Licence: NY 011404) | |
| 103TH0004X Psychologist, Health (Licence: NY 011404) | |
| Enumeration Date | 2008-04-09 |
| Last Update Date | 2015-08-12 |