| NPI | 1326726100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH24273) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NJ 37PC00853400) |
| Enumeration Date | 2023-07-10 |
| Last Update Date | 2025-05-27 |