| NPI | 1942686985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 021247) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NY 021247) |
| 103TE1100X Psychologist, Exercise & Sports (Licence: NY 021247) | |
| 103TH0004X Psychologist, Health (Licence: NY 021247) | |
| 103TH0100X Psychologist, Health Service (Licence: NY 021247) | |
| 103TR0400X Psychologist, Rehabilitation (Licence: NY 021247) | |
| 103G00000X Clinical Neuropsychologist (Licence: NY 021247) | |
| 103T00000X Psychologist (Licence: NY 021247) | |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: NY 021247) | |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: NY 021247) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: NY 021247) | |
| Enumeration Date | 2015-07-31 |
| Last Update Date | 2015-10-27 |