| NPI | 1639651649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NY 012963) |
| Additional Taxonomies | 225C00000X Rehabilitation Counselor (Licence: NY 00344823) |
| Enumeration Date | 2018-09-06 |
| Last Update Date | 2024-02-27 |