| NPI | 1770882466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 021628) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 003583) |
| Enumeration Date | 2011-03-21 |
| Last Update Date | 2016-06-10 |