| NPI | 1417387176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 005829) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NJ 37PC00659300) |
| Enumeration Date | 2013-11-17 |
| Last Update Date | 2023-02-13 |