| NPI | 1447394283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NY 010315-1) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 010315-1) |
| 103TA0400X Psychologist Addiction (Substance Use Disorder) (Licence: NY 010315-1) | |
| 103TH0100X Psychologist Health Service (Licence: NY 010315-1) | |
| 103TP2701X Psychologist Group Psychotherapy (Licence: NY 010315-1) | |
| Enumeration Date | 2007-02-16 |
| Last Update Date | 2024-04-25 |