Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003216003 |
---|---|
Provider Name | Eric Lafayette |
First Address | New York, NY 10004-1607 |
Second Address | New York, NY 10004-1607 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2014 |
Last Update Date | 26/08/2014 |