| NPI | 1326812918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NJ 37AC00668400) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NJ 37AC00668400) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NJ 37AC00668400) | |
| 102L00000X Psychoanalyst (Licence: NJ 37AC00668400) | |
| Enumeration Date | 2023-11-14 |
| Last Update Date | 2023-11-14 |