| NPI | 1811984107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: NY 010122-1) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: NY 010122-2) |
| Enumeration Date | 2005-10-01 |
| Last Update Date | 2016-12-05 |