NPI | 1801951579 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 013030) |
Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: NV PY0489) |
103TC0700X Psychologist, Clinical (Licence: NV PY0489) | |
Enumeration Date | 2006-12-23 |
Last Update Date | 2025-09-11 |