| NPI | 1508671991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 092366) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 092366) |
| Enumeration Date | 2025-02-11 |
| Last Update Date | 2025-04-21 |