| NPI | 1649690900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 006459) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL mh12901) |
| Enumeration Date | 2014-04-24 |
| Last Update Date | 2015-11-18 |