| NPI | 1073121711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY P105966) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 012549) |
| Enumeration Date | 2020-07-20 |
| Last Update Date | 2022-12-06 |