| NPI | 1578963757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NJ 37pc00698200) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YM0800X Counselor, Mental Health (Licence: NJ 37pc00698200) | |
| Enumeration Date | 2014-08-25 |
| Last Update Date | 2023-03-17 |