| NPI | 1386893964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 007918-1) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: NY 007918-1) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: NY 007918-1) | |
| 103TC0700X Psychologist, Clinical (Licence: NY 007918-1) | |
| 103TR0400X Psychologist, Rehabilitation (Licence: NY 007918-1) | |
| Enumeration Date | 2008-09-18 |
| Last Update Date | 2008-09-18 |