| NPI | 1689239659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 012620) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NJ 37PC01025300) |
| Enumeration Date | 2019-05-06 |
| Last Update Date | 2024-06-12 |