| NPI | 1003549106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CT 005916) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 012357) |
| Enumeration Date | 2022-07-06 |
| Last Update Date | 2022-12-05 |