| NPI | 1376211672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 013397) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY P108438) |
| Enumeration Date | 2021-09-01 |
| Last Update Date | 2025-12-05 |