| NPI | 1649580002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH 13682) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 7246634) |
| Enumeration Date | 2010-10-19 |
| Last Update Date | 2015-09-16 |