| NPI | 1265717615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 004871-1) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CT 009413) |
| Enumeration Date | 2011-10-17 |
| Last Update Date | 2026-02-15 |