| NPI | 1871889402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NY 9328) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: MA 8636) |
| 101YP2500X Counselor Professional (Licence: NY 9328) | |
| Enumeration Date | 2011-06-22 |
| Last Update Date | 2020-11-10 |