| NPI | 1639336522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225C00000X Rehabilitation Counselor (Licence: NY CRC # 00088304) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NY 004380) |
| Enumeration Date | 2008-05-19 |
| Last Update Date | 2011-06-17 |