| NPI | 1609934397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 000087) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2024-11-07 |