| NPI | 1154835502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NY 003916) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NY 003916) |
| Enumeration Date | 2017-11-21 |
| Last Update Date | 2017-11-21 |