| NPI | 1194304170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH21074) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 011209) |
| Enumeration Date | 2021-04-06 |
| Last Update Date | 2023-05-17 |