| NPI | 1972131407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 012048) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2020-03-30 |
| Last Update Date | 2022-03-18 |