| NPI | 1033372024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH6242) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 1614-1) |
| Enumeration Date | 2008-07-09 |
| Last Update Date | 2017-11-16 |