NPI | 1821153560 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: NY 012091-1) |
Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: NY 012091-1) |
103TC0700X Psychologist, Clinical (Licence: NY 012091-1) | |
103TC1900X Psychologist, Counseling (Licence: NY 012091-01) | |
103TF0000X Psychologist, Family (Licence: NY 012091-1) | |
103TP2701X Psychologist, Group Psychotherapy (Licence: NY 012091-1) | |
Enumeration Date | 2006-12-22 |
Last Update Date | 2020-12-18 |