| NPI | 1033627534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 008995) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: VA 0701007453) |
| Enumeration Date | 2018-01-18 |
| Last Update Date | 2018-09-12 |