| NPI | 1801341565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CT 002791) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 006102-1) |
| Enumeration Date | 2016-08-23 |
| Last Update Date | 2016-08-23 |