| NPI | 1134844509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NY 024961) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 101YP2500X Counselor Professional | |
| 103TF0200X Psychologist Forensic | |
| Enumeration Date | 2022-10-07 |
| Last Update Date | 2022-10-14 |