| NPI | 1487703740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 010268-1) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NY 010268-1) |
| 103TF0000X Psychologist, Family (Licence: NY 010268-1) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: NY 010268-1) | |
| 103TS0200X Psychologist, School (Licence: NY 010268-1) | |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2007-07-08 |