| NPI | 1275014888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NJ 37PC00896400) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NJ 37PC00896400) |
| 101YP2500X Counselor, Professional (Licence: NJ 37AC00423400) | |
| Enumeration Date | 2018-08-22 |
| Last Update Date | 2024-10-08 |