| NPI | 1699249102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 012382) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2019-01-17 |
| Last Update Date | 2024-05-23 |