| NPI | 1467685347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 005267) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 18 P68132) |
| Enumeration Date | 2009-08-26 |
| Last Update Date | 2013-11-08 |