| NPI | 1477769818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: NY 003721) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 003721) |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2025-09-11 |