| NPI | 1225634272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 012303-01) |
| Additional Taxonomies | 103TS0200X Psychologist, School |
| Enumeration Date | 2020-12-07 |
| Last Update Date | 2022-04-21 |