| NPI | 1881749539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: NC 3635) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: NY 012695) |
| 103TA0400X Psychologist Addiction (Substance Use Disorder) (Licence: NY 012695) | |
| 103TA0700X Psychologist Adult Development & Aging (Licence: NY 012695) | |
| 103TC0700X Psychologist Clinical (Licence: NY 012695) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: NY 012695) | |
| 103TF0200X Psychologist Forensic (Licence: NY 012695) | |
| 103TA0400X Psychologist Addiction (Substance Use Disorder) (Licence: NC 3635) | |
| 103TA0700X Psychologist Adult Development & Aging (Licence: NC 3635) | |
| 103TC0700X Psychologist Clinical (Licence: NC 3635) | |
| 103TF0200X Psychologist Forensic (Licence: NC 3635) | |
| 106H00000X Marriage & Family Therapist (Licence: NC 3635) | |
| 103TP0814X Psychologist Psychoanalysis (Licence: NC 3635) | |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2011-07-18 |