| NPI | 1467798744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 005803-1) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH11465) |
| Enumeration Date | 2012-12-14 |
| Last Update Date | 2022-07-25 |