| NPI | 1073289740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY D013932) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ME CC8308) |
| Enumeration Date | 2021-08-21 |
| Last Update Date | 2025-10-29 |