| NPI | 1700478641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH-23263) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 011062) |
| Enumeration Date | 2021-02-10 |
| Last Update Date | 2024-10-30 |