| NPI | 1609993047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 12979) |
| 101YM0800X Counselor, Mental Health (Licence: NY 000104) | |
| 101YP2500X Counselor, Professional (Licence: NJ 37PC00329700) | |
| 103TC1900X Psychologist, Counseling | |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2024-08-29 |