| NPI | 1053781484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NJ 37AC00266300) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NJ 37AC00266300) |
| Enumeration Date | 2015-09-28 |
| Last Update Date | 2015-09-28 |