| NPI | 1649254970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NY 006658) |
| Additional Taxonomies | 103TA0700X Psychologist Adult Development & Aging (Licence: NY 006658) |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: NY 006658) | |
| 103TF0000X Psychologist Family (Licence: NY 006658) | |
| 103TR0400X Psychologist Rehabilitation (Licence: NY 006658) | |
| Enumeration Date | 2005-11-30 |
| Last Update Date | 2007-12-17 |