| NPI | 1073020921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NJ 37PC00723300) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NJ 37AC00348400) |
| Enumeration Date | 2018-01-01 |
| Last Update Date | 2023-04-13 |