| NPI | 1518974963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NJ 44SCOO17600) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NJ SC00176) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2008-04-23 |