| NPI | 1801918677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NY 000661) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: NY 006034) |
| 103TC0700X Psychologist, Clinical (Licence: NY 006034) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NY 006034) | |
| 103TF0000X Psychologist, Family (Licence: NY 006034) | |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2025-09-11 |