| NPI | 1679326318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: NY 11983701) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 11983701) |
| 101Y00000X Counselor (Licence: NY 11983701) | |
| Enumeration Date | 2024-04-11 |
| Last Update Date | 2024-04-11 |