| NPI | 1447245428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY #5597) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY #4147) |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) | |
| 103TA0700X Psychologist, Adult Development & Aging | |
| 103TC1900X Psychologist, Counseling | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities | |
| Enumeration Date | 2005-09-15 |
| Last Update Date | 2016-01-05 |