| NPI | 1720481930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY p94437) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 007195) |
| Enumeration Date | 2014-10-01 |
| Last Update Date | 2016-08-22 |