| NPI | 1689359937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NY 001465) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: FL 15672) |
| Enumeration Date | 2023-06-15 |
| Last Update Date | 2023-06-15 |