| NPI | 1770676272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 008773) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 008773) |
| 103TC0700X Psychologist, Clinical (Licence: NY 008773) | |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2025-09-11 |