| NPI | 1487012050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY P00905) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 008585) |
| Enumeration Date | 2016-02-10 |
| Last Update Date | 2018-04-16 |