| NPI | 1437743994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 013962) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NJ 37PC01081100) |
| Enumeration Date | 2021-02-25 |
| Last Update Date | 2025-11-21 |