| NPI | 1043309537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist Counseling (Licence: NY 022114) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: MA 4901) |
| 103TC0700X Psychologist Clinical (Licence: NY 022114) | |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2018-09-26 |