| NPI | 1598209595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NJ TP# 163-066) |
| Additional Taxonomies | 103TS0200X Psychologist School (Licence: NJ 989192) |
| Enumeration Date | 2016-12-09 |
| Last Update Date | 2016-12-09 |