| NPI | 1487705596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 000070) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: PA 002275) |
| Enumeration Date | 2007-01-15 |
| Last Update Date | 2007-07-08 |