| NPI | 1356506513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NJ 37PC00487600) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR C3542) |
| 101YM0800X Counselor, Mental Health (Licence: PA PC007980) | |
| Enumeration Date | 2008-07-26 |
| Last Update Date | 2016-09-08 |