| NPI | 1831606516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 01068001) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY P08963) |
| Enumeration Date | 2018-01-04 |
| Last Update Date | 2021-04-08 |