| NPI | 1043877806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 012393) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NJ 37PC01121900) |
| Enumeration Date | 2019-05-28 |
| Last Update Date | 2025-04-18 |