| NPI | 1275060766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NJ 37PC00608900) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NJ 37AC00219900) |
| Enumeration Date | 2017-05-16 |
| Last Update Date | 2022-03-25 |