| NPI | 1073983938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 000451) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 094367) |
| Enumeration Date | 2015-10-04 |
| Last Update Date | 2017-03-12 |