| 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: NJ 37PC00904500) |
| Enumeration Date | 2017-03-26 |
| Last Update Date | 2024-05-08 |