| NPI | 1548617855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 001811) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 001811-01) |
| Enumeration Date | 2016-05-17 |
| Last Update Date | 2022-05-05 |