| NPI | 1922013358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 003893-01) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 3893) |
| 103TF0000X Psychologist, Family (Licence: NY 3893) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: NY 3893) | |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2025-04-24 |