| NPI | 1831530500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: NY 113509851) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 002449-1) |
| Enumeration Date | 2013-07-10 |
| Last Update Date | 2013-07-10 |