| NPI | 1235492984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 001258) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NY 001258) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 001258) | |
| 101YP2500X Counselor, Professional (Licence: NY 001258) | |
| 102L00000X Psychoanalyst (Licence: NY 001258) | |
| 103TC1900X Psychologist, Counseling (Licence: NY 001258) | |
| 106H00000X Marriage & Family Therapist (Licence: NY 001258) | |
| Enumeration Date | 2012-06-18 |
| Last Update Date | 2012-06-18 |