| NPI | 1477963296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NY 007010-1) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NY P91644) |
| Enumeration Date | 2014-05-01 |
| Last Update Date | 2019-11-18 |