| NPI | 1134270622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist Counseling (Licence: NY 024330) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NY 003777) |
| Enumeration Date | 2007-01-13 |
| Last Update Date | 2021-05-27 |