| NPI | 1790149102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 021546) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NY 021546) |
| 103TP2701X Psychologist, Group Psychotherapy | |
| Enumeration Date | 2016-04-12 |
| Last Update Date | 2016-04-12 |