| NPI | 1205859337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 001997-01) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 001997) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2023-11-02 |