| NPI | 1417517004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NJ 37PC01021400) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NJ 37AC00410000) |
| Enumeration Date | 2019-06-17 |
| Last Update Date | 2024-04-10 |