| NPI | 1518188788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 008728) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL LMHC5613) |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2018-06-27 |