| NPI | 1790975290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 6820) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 003523-1) |
| Enumeration Date | 2007-07-31 |
| Last Update Date | 2015-11-24 |