| NPI | 1114321684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NJ 37PC00720000) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YP2500X Counselor, Professional (Licence: PA PC009654) | |
| Enumeration Date | 2014-10-13 |
| Last Update Date | 2021-08-29 |