| NPI | 1295993053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NJ 37PC00060900) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NJ 37PC00060900) |
| 101YP2500X Counselor Professional (Licence: NJ 37PC00060900) | |
| Enumeration Date | 2008-05-29 |
| Last Update Date | 2008-07-08 |