| NPI | 1134869472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 016447) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NJ 37PC01229200) |
| Enumeration Date | 2022-04-01 |
| Last Update Date | 2026-02-05 |