| NPI | 1154547800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 003008-1) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: NY 1339260) |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2011-12-05 |