| NPI | 1861748063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NY 007606) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CT 7178) |
| 101Y00000X Counselor (Licence: OH E.0900032) | |
| 101YP2500X Counselor, Professional (Licence: NJ 37PC01034500) | |
| Enumeration Date | 2012-07-25 |
| Last Update Date | 2024-05-15 |