| NPI | 1578124707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 014108-01) |
| Enumeration Date | 2019-06-27 |
| Last Update Date | 2024-03-06 |