| NPI | 1457715526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NJ 37PC00879400) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 001747) |
| Enumeration Date | 2016-04-05 |
| Last Update Date | 2023-03-09 |