| NPI | 1114581600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CA 11507) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 010811) |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2019-04-30 |
| Last Update Date | 2022-05-26 |