| NPI | 1700108701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 7716-1) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: NY 7716-1) |
| 103TF0200X Psychologist, Forensic (Licence: NY 7716-1) | |
| Enumeration Date | 2010-02-18 |
| Last Update Date | 2010-02-18 |