| NPI | 1558400796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist Counseling (Licence: CA PSY19635) |
| Additional Taxonomies | 103TC1900X Psychologist Counseling (Licence: NY 14792) |
| 103TC0700X Psychologist Clinical (Licence: NY 14792) | |
| 103TC0700X Psychologist Clinical (Licence: CA PSY19635) | |
| 103TA0400X Psychologist Addiction (Substance Use Disorder) (Licence: NY 14792) | |
| 103TA0400X Psychologist Addiction (Substance Use Disorder) (Licence: CA PSY19635) | |
| 103T00000X Psychologist (Licence: NY 14792) | |
| 103T00000X Psychologist (Licence: CA PSY19635) | |
| 103TP2701X Psychologist Group Psychotherapy (Licence: NY 14792) | |
| 103TP2701X Psychologist Group Psychotherapy (Licence: CA PSY19635) | |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2007-07-08 |