NPI | 1245580976 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor Professional (Licence: NJ 37PC00601200) |
Additional Taxonomies | 101YM0800X Counselor Mental Health |
Enumeration Date | 2012-09-10 |
Last Update Date | 2018-03-17 |