| NPI | 1790550168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: CT 004199) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NY 116011) |
| Enumeration Date | 2023-11-16 |
| Last Update Date | 2023-11-16 |