NPI | 1053494336 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 000055-01) |
Additional Taxonomies | 103T00000X Psychologist (Licence: NY 0000551) |
Enumeration Date | 2006-10-23 |
Last Update Date | 2025-05-07 |