| NPI | 1982453197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 118079-01) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NJ 44SL06913300) |
| Enumeration Date | 2024-05-18 |
| Last Update Date | 2024-05-18 |