| NPI | 1801011747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 3477) |
| Additional Taxonomies | 103TH0100X Psychologist, Health Service (Licence: MA PY846-PR) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2007-07-08 |