| NPI | 1932273117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 0001201) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: NY 000120-01) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NY 837238981) | |
| 103TS0200X Psychologist, School (Licence: NY 837237981) | |
| 106H00000X Marriage & Family Therapist (Licence: NY 000120-01) | |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2020-06-09 |