| NPI | 1437882479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NJ 37PC0121690) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: PA PC019598) |
| Enumeration Date | 2022-07-07 |
| Last Update Date | 2026-02-13 |