| NPI | 1902337413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 009113) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CT 006466) |
| 101YP2500X Counselor, Professional (Licence: NJ 37PC00904500) | |
| Enumeration Date | 2017-03-26 |
| Last Update Date | 2025-02-06 |