| NPI | 1689124570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY P98951) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 008563) |
| Enumeration Date | 2016-10-04 |
| Last Update Date | 2018-05-12 |