| NPI | 1376185728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NJ 37PC01090900) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NJ 37AC00486900) |
| Enumeration Date | 2019-10-16 |
| Last Update Date | 2024-12-11 |