| NPI | 1033405949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 000795-1) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NY 039729-1) |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2011-07-07 |