| NPI | 1366887440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NJ 37PC00658100) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AL C1700A) |
| Enumeration Date | 2013-05-02 |
| Last Update Date | 2021-08-30 |