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 |