| NPI | 1073757746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 005276) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: NY 2183213) |
| Enumeration Date | 2009-04-26 |
| Last Update Date | 2018-06-13 |