| NPI | 1558057828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 013423) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY P110072) |
| Enumeration Date | 2023-04-11 |
| Last Update Date | 2023-08-16 |