| NPI | 1821016825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: GA 004603) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY PR-017507-1) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2007-07-08 |