| NPI | 1033645163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 007765) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: SC 7232) |
| Enumeration Date | 2017-05-10 |
| Last Update Date | 2026-04-23 |