| NPI | 1033805098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NJ 37PC00936600) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NJ 37PC00936600) |
| Enumeration Date | 2023-04-13 |
| Last Update Date | 2025-03-02 |