| NPI | 1033593660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH17607) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 006661) |
| Enumeration Date | 2015-07-14 |
| Last Update Date | 2022-11-09 |