| NPI | 1336707660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 105872) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MA LMHC10001384) |
| Enumeration Date | 2019-06-01 |
| Last Update Date | 2025-12-11 |