| NPI | 1760029524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 012782) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CT 3945) |
| Enumeration Date | 2019-11-28 |
| Last Update Date | 2023-01-06 |