NPI | 1649484171 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 29631) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 009423) |
103TP2701X Psychologist, Group Psychotherapy (Licence: NY 009423) | |
Enumeration Date | 2007-05-10 |
Last Update Date | 2025-09-11 |