| NPI | 1215426408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 010509) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY P09856) |
| Enumeration Date | 2018-05-03 |
| Last Update Date | 2020-12-30 |