| NPI | 1083990238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 183700000X Pharmacy Technician (Licence: NJ 28RW00369100) |
| Enumeration Date | 2011-11-01 |
| Last Update Date | 2022-11-12 |