| NPI | 1245702851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NJ 37PC00653600) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: PA PC007847) |
| Enumeration Date | 2018-12-20 |
| Last Update Date | 2018-12-20 |