| 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 |