| NPI | 1588741730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 013619) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: NY 013619) |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: NY 013619) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2011-02-18 |