| NPI | 1386122927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NY 009943) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: HI 744) |
| Enumeration Date | 2018-08-06 |
| Last Update Date | 2023-06-22 |