| NPI | 1316553753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NY 012527) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NY 106803-01) |
| 101Y00000X Counselor (Licence: NY 106803-01) | |
| 101YM0800X Counselor Mental Health (Licence: NY 106803-01) | |
| 101YP1600X Counselor Pastoral (Licence: NY 106803-01) | |
| 101YP2500X Counselor Professional (Licence: NY 106803-01) | |
| Enumeration Date | 2020-09-21 |
| Last Update Date | 2023-07-25 |