| NPI | 1184190969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NY 010998) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NY P09759) |
| Enumeration Date | 2018-10-18 |
| Last Update Date | 2025-04-30 |