| NPI | 1164726808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NJ 37pc00610000) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 004666) |
| Enumeration Date | 2011-01-10 |
| Last Update Date | 2023-09-28 |