| NPI | 1497130793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 008536) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY P97907) |
| Enumeration Date | 2015-07-28 |
| Last Update Date | 2025-11-19 |