| NPI | 1669523106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 016597) |
| Additional Taxonomies | 103TF0200X Psychologist, Forensic (Licence: NY 016597) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: NY 016597) | |
| 103TF0000X Psychologist, Family (Licence: NY 016597) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: NY 016597) | |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2017-02-25 |