| NPI | 1477025039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH19817) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY P14374) |
| Enumeration Date | 2018-12-20 |
| Last Update Date | 2021-11-03 |