| NPI | 1699931311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 081315-1) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NY 081315-1) |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: NY 081315-1) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: NY 081315-1) | |
| 106H00000X Marriage & Family Therapist (Licence: NY 081315-1) | |
| 103TC0700X Psychologist, Clinical (Licence: NY 081315-1) | |
| Enumeration Date | 2008-08-01 |
| Last Update Date | 2010-06-08 |