| NPI | 1801129085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 018117-1) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 018117-1) |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: NY 018117-1) | |
| 103TC1900X Psychologist, Counseling (Licence: NY 018117-1) | |
| 103TH0004X Psychologist, Health (Licence: NY 018117-1) | |
| 103TH0100X Psychologist, Health Service (Licence: NY 018117-1) | |
| Enumeration Date | 2009-09-07 |
| Last Update Date | 2009-09-07 |