| NPI | 1942690276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 008502) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: 0) |
| Enumeration Date | 2015-01-26 |
| Last Update Date | 2020-09-10 |