| NPI | 1912532136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 012184) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 104703-01) |
| 101YP2500X Counselor, Professional (Licence: FL TPMC1863) | |
| Enumeration Date | 2020-03-09 |
| Last Update Date | 2022-03-09 |