| NPI | 1093165011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 093052) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 086755) |
| Enumeration Date | 2016-06-21 |
| Last Update Date | 2020-02-12 |