| NPI | 1629629381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 010742) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY P13278) |
| Enumeration Date | 2019-09-24 |
| Last Update Date | 2020-10-01 |