| NPI | 1457008880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC A17386) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 112626-01) |
| Enumeration Date | 2022-03-06 |
| Last Update Date | 2022-07-27 |