| NPI | 1558737916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NY 023543) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| Enumeration Date | 2015-08-19 |
| Last Update Date | 2022-07-13 |