| 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 |