| NPI | 1952746141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NY 008137) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: PA PC013511) |
| Enumeration Date | 2013-05-02 |
| Last Update Date | 2022-01-14 |