| NPI | 1184330649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NJ 37PC01120900) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0022042) |
| Enumeration Date | 2023-01-27 |
| Last Update Date | 2025-10-07 |