| NPI | 1609086594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 006027) |
| Additional Taxonomies | 103TA0400X Psychologist Addiction (Substance Use Disorder) (Licence: NY 006027) |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: NY 006027) | |
| 103TC0700X Psychologist Clinical (Licence: NY 006027) | |
| 103TC1900X Psychologist Counseling (Licence: NY 006027) | |
| 103TF0000X Psychologist Family (Licence: NY 006027) | |
| 103TH0100X Psychologist Health Service (Licence: NY 006027) | |
| 103TS0200X Psychologist School | |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2007-07-26 |