| NPI | 1730251968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: NY 009669) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 009669) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: NY 009669) | |
| 103TC0700X Psychologist, Clinical (Licence: NY 009669) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NY 009669) | |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2025-09-11 |