| NPI | 1649525304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 024864) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 174400000X Specialist | |
| Enumeration Date | 2012-07-18 |
| Last Update Date | 2022-05-24 |