| NPI | 1760883540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 009130) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY P91991) |
| Enumeration Date | 2014-09-11 |
| Last Update Date | 2023-02-06 |