| NPI | 1134411853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: SC 5755) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 005692) |
| Enumeration Date | 2011-05-13 |
| Last Update Date | 2017-02-17 |