| NPI | 1093311672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 010822) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 103TC1900X Psychologist, Counseling (Licence: NY 010822) | |
| Enumeration Date | 2020-12-08 |
| Last Update Date | 2022-06-14 |