| NPI | 1639458789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 009547) |
| Additional Taxonomies | 101YS0200X Counselor, School (Licence: NY 009547) |
| Enumeration Date | 2011-08-08 |
| Last Update Date | 2019-11-05 |