| NPI | 1619460672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 010893) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: SC 6854) |
| 101YP2500X Counselor, Professional (Licence: NY 010893) | |
| Enumeration Date | 2018-06-13 |
| Last Update Date | 2021-09-03 |