| NPI | 1518992734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH9535) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NJ 37PC00313700) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2010-02-22 |