| NPI | 1518230317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: LA 6496) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 005000) |
| Enumeration Date | 2012-02-10 |
| Last Update Date | 2019-05-08 |