| NPI | 1518401363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NJ 37PC00729800) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NJ 37AC00338200) |
| Enumeration Date | 2016-12-13 |
| Last Update Date | 2023-05-04 |