| NPI | 1073543161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 010345) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NY 010345) |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2022-12-22 |