| NPI | 1841027919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 015080) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NJ 37PC01131200) |
| Enumeration Date | 2024-09-13 |
| Last Update Date | 2026-04-21 |