| NPI | 1194266817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NJ 37PC00575300) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH12828) |
| Enumeration Date | 2017-03-14 |
| Last Update Date | 2022-07-21 |