| NPI | 1366041840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0018398) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NJ 37PC00954200) |
| Enumeration Date | 2020-10-26 |
| Last Update Date | 2024-06-06 |