| NPI | 1801958418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 013505) |
| Additional Taxonomies | 103TP2701X Psychologist, Group Psychotherapy (Licence: NY 013505) |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) | |
| 103TH0100X Psychologist, Health Service | |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2016-04-05 |