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 |