| NPI | 1902785496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NY 128524) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NY 128524) |
| 104100000X Social Worker (Licence: NY 128524) | |
| Enumeration Date | 2025-08-28 |
| Last Update Date | 2025-08-28 |