| NPI | 1649728122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 009868) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: GA LPC009183) |
| Enumeration Date | 2016-09-14 |
| Last Update Date | 2025-03-24 |