| NPI | 1407495088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 010829) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 85939) |
| 101YM0800X Counselor, Mental Health (Licence: NE 2837) | |
| 101YM0800X Counselor, Mental Health (Licence: IN 39004440A) | |
| 101YM0800X Counselor, Mental Health (Licence: IL 180.018276) | |
| 101YM0800X Counselor, Mental Health (Licence: VA 0701012318) | |
| Enumeration Date | 2019-12-31 |
| Last Update Date | 2026-06-30 |