| NPI | 1861164220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: RI MHC01566) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 014067) |
| Enumeration Date | 2021-10-04 |
| Last Update Date | 2024-09-23 |