| NPI | 1417205600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 001744-1) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NJ 37RT00432300) |
| Enumeration Date | 2012-08-21 |
| Last Update Date | 2012-08-21 |