| NPI | 1417427774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 022159) |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral (Licence: NY 022159) |
| 103TC0700X Psychologist Clinical (Licence: NY 022159) | |
| 103TH0004X Psychologist Health (Licence: NY 022159) | |
| 103TP2701X Psychologist Group Psychotherapy (Licence: NY 022159) | |
| Enumeration Date | 2018-11-29 |
| Last Update Date | 2018-11-29 |