| NPI | 1194965970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 019130) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 070791) |
| Enumeration Date | 2009-03-06 |
| Last Update Date | 2023-10-30 |