| NPI | 1376621037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NY 012176) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 012176) |
| 101YP2500X Counselor Professional (Licence: FL MH4185) | |
| 101YP2500X Counselor Professional (Licence: NC 8198) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2014-02-26 |