| NPI | 1154997690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 107266-01) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 10726601) |
| Enumeration Date | 2021-06-03 |
| Last Update Date | 2021-06-04 |