| NPI | 1003198276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NJ 44SC05895200) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 088762) |
| Enumeration Date | 2011-09-14 |
| Last Update Date | 2020-02-18 |