| NPI | 1518517804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: NJ 37PC00677800) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NJ 37PC00677800) |
| Enumeration Date | 2019-09-18 |
| Last Update Date | 2024-06-21 |