| NPI | 1861909004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: P09068) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY P09068) |
| Enumeration Date | 2018-01-09 |
| Last Update Date | 2018-01-09 |