| NPI | 1578876983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 003312) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 103TS0200X Psychologist, School | |
| Enumeration Date | 2010-07-15 |
| Last Update Date | 2022-10-18 |