| NPI | 1790805497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 004290-1) |
| Additional Taxonomies | 101YP1600X Counselor Pastoral |
| 103TA0400X Psychologist Addiction (Substance Use Disorder) (Licence: NY 004290-1) | |
| 103TC1900X Psychologist Counseling (Licence: NY 004290-1) | |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2008-09-18 |