| NPI | 1366041220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NJ 37FA00034600) |
| Additional Taxonomies | 224Y00000X Clinical Exercise Physiologist |
| 106H00000X Marriage & Family Therapist (Licence: Student) | |
| Enumeration Date | 2020-10-21 |
| Last Update Date | 2023-02-14 |