| NPI | 1366851909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 020735) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: NY 020735) |
| 103TC1900X Psychologist, Counseling (Licence: NY 020735) | |
| Enumeration Date | 2014-08-07 |
| Last Update Date | 2014-09-10 |