| NPI | 1013164003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH8769) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NJ 37PC00340900) |
| Enumeration Date | 2008-08-21 |
| Last Update Date | 2008-08-21 |