| NPI | 1326604265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 011108-01) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY P14104) |
| Enumeration Date | 2019-05-16 |
| Last Update Date | 2026-04-30 |