| NPI | 1588499669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 014090) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 011615) |
| Enumeration Date | 2024-09-06 |
| Last Update Date | 2024-09-06 |