| NPI | 1922309939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 003987) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: PR 000752) |
| Enumeration Date | 2010-11-07 |
| Last Update Date | 2010-11-07 |