| NPI | 1851385546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 6557-1) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: NY 6557-1) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NY 6557-1) | |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: NY 6557-1) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: NY 6557-1) | |
| Enumeration Date | 2005-09-08 |
| Last Update Date | 2013-05-07 |