| NPI | 1972526481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 000928-1) |
| Additional Taxonomies | 101YS0200X Counselor, School |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2021-09-28 |