| NPI | 1811948441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CT 001636) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 008855) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CT 001636) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NY 08855) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CT 001636) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: NY 008855) | |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2015-09-21 |