| NPI | 1215549589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 024934) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 103TC0700X Psychologist, Clinical (Licence: NY 024934) | |
| Enumeration Date | 2020-08-18 |
| Last Update Date | 2022-05-02 |