| NPI | 1144728148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 010087) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL TPMC7301) |
| 101YM0800X Counselor, Mental Health (Licence: VT 068.0134618TELE) | |
| Enumeration Date | 2018-01-25 |
| Last Update Date | 2026-08-07 |