| NPI | 1871682401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: NY R0598381) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MD 28878) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2023-02-09 |