| NPI | 1992912539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 002709) |
| Additional Taxonomies | 101YS0200X Counselor, School |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2007-07-08 |