| NPI | 1790958940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: NY 006325) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 006325) |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: NY 006325) | |
| 103TF0200X Psychologist, Forensic (Licence: NY 006325) | |
| Enumeration Date | 2008-04-09 |
| Last Update Date | 2018-04-13 |