| NPI | 1679092928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 023907) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| Enumeration Date | 2017-09-18 |
| Last Update Date | 2020-11-19 |