| NPI | 1508035544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY8952) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 103TC0700X Psychologist, Clinical (Licence: NY 024838) | |
| Enumeration Date | 2008-02-25 |
| Last Update Date | 2025-02-11 |