| NPI | 1518629567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 011559) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: PA PC015772) |
| Enumeration Date | 2021-10-07 |
| Last Update Date | 2023-06-20 |