| NPI | 1417224668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 005798) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY P82476) |
| Enumeration Date | 2011-11-16 |
| Last Update Date | 2021-08-11 |