| NPI | 1609465384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 011003) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CT 7374) |
| Enumeration Date | 2021-01-15 |
| Last Update Date | 2024-09-24 |