| NPI | 1649484171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 009423) |
| Additional Taxonomies | 103TP2701X Psychologist, Group Psychotherapy (Licence: NY 009423) |
| 1041C0700X Social Worker, Clinical (Licence: NY 29631) | |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2007-07-08 |