| NPI | 1578913729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 008587-1) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2016-06-20 |
| Last Update Date | 2018-07-12 |