| NPI | 1427521087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: SC 7015) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 008729-1) |
| Enumeration Date | 2019-01-07 |
| Last Update Date | 2019-07-18 |