| NPI | 1740899376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 014546) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY P111106) |
| Enumeration Date | 2020-07-29 |
| Last Update Date | 2024-04-03 |