| NPI | 1952951931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 013180) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 102358-01) |
| Enumeration Date | 2019-09-12 |
| Last Update Date | 2023-02-02 |