| NPI | 1043533151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NJ 37PC00659900) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: VA 0701006314) |
| 101YM0800X Counselor, Mental Health (Licence: NC 9034) | |
| Enumeration Date | 2010-03-03 |
| Last Update Date | 2020-04-16 |