| NPI | 1669700720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 016307) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: NY 016307) |
| 103TC1900X Psychologist, Counseling (Licence: NY 016307) | |
| 103TE1100X Psychologist, Exercise & Sports (Licence: NY 016307) | |
| Enumeration Date | 2009-12-01 |
| Last Update Date | 2009-12-01 |