| NPI | 1710055108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA 8402) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 7208) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MA 8402) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NY 7208) | |
| 103TP0814X Psychologist, Psychoanalysis (Licence: MA 8402) | |
| 103TP0814X Psychologist, Psychoanalysis (Licence: NY 7208) | |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: NY 7208) | |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: MA 8402) | |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2011-12-08 |