| NPI | 1194070730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NY 005158) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 36451) |
| Enumeration Date | 2012-07-19 |
| Last Update Date | 2012-10-08 |