| NPI | 1003405366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 106795-01) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 013399) |
| Enumeration Date | 2021-01-12 |
| Last Update Date | 2025-06-23 |