| 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 |