| NPI | 1770206443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 012270) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA LPCC13846) |
| Enumeration Date | 2022-09-19 |
| Last Update Date | 2024-11-13 |