| NPI | 1891163804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NY 007837) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 74384) |
| 103TC1900X Psychologist, Counseling (Licence: NY 007837) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NY 007837) | |
| Enumeration Date | 2015-09-08 |
| Last Update Date | 2024-11-18 |