| NPI | 1437113412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NY 015299) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 15299) |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: NY 015299) | |
| 103TF0000X Psychologist Family (Licence: NY 015299) | |
| 106H00000X Marriage & Family Therapist (Licence: NY 000315) | |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2023-07-05 |