| NPI | 1558622589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 006800) |
| Enumeration Date | 2012-06-06 |
| Last Update Date | 2021-03-18 |