| NPI | 1396880423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 001699) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NY 001699) |
| 101YP2500X Counselor, Professional (Licence: NY 001699) | |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2019-06-05 |