| NPI | 1326691940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 010281) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY P08509) |
| Enumeration Date | 2019-07-23 |
| Last Update Date | 2023-04-16 |