| NPI | 1336731413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 012254) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 120111) |
| Enumeration Date | 2021-02-09 |
| Last Update Date | 2023-10-27 |