| NPI | 1407819469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 000304) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 15536) |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2015-04-27 |