| NPI | 1538674312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WI 6786-125) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 008376) |
| Enumeration Date | 2017-12-03 |
| Last Update Date | 2022-08-16 |