| NPI | 1982789970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 6339) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: NY 6339) |
| 103TF0000X Psychologist, Family (Licence: NY 6339) | |
| 103T00000X Psychologist (Licence: NY 6339) | |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2010-01-14 |