| NPI | 1497380042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 015237) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 100081-01) |
| Enumeration Date | 2020-03-04 |
| Last Update Date | 2024-10-21 |