| NPI | 1265069298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: 37PC00040300) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NJ 37PC00040300) |
| 101Y00000X Counselor | |
| Enumeration Date | 2020-03-27 |
| Last Update Date | 2020-03-27 |