| NPI | 1053063198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NY 013882) |
| Enumeration Date | 2022-01-20 |
| Last Update Date | 2024-07-01 |