| NPI | 1922765858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 012855) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 103967-01) |
| Enumeration Date | 2021-11-28 |
| Last Update Date | 2023-01-31 |