| NPI | 1306367925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 009798) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY P06393) |
| Enumeration Date | 2017-07-05 |
| Last Update Date | 2024-05-13 |