| NPI | 1104201912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NJ 44SL06027600) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NJ 093907) |
| Enumeration Date | 2015-07-22 |
| Last Update Date | 2015-07-22 |