| NPI | 1588319610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 014277) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY P111163) |
| Enumeration Date | 2022-02-17 |
| Last Update Date | 2024-05-07 |