| NPI | 1619360088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NJ 44SL05216700) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NJ 44SL05216700) |
| 102L00000X Psychoanalyst (Licence: NJ 44SL05216700) | |
| 106H00000X Marriage & Family Therapist (Licence: NJ 44SL05216700) | |
| Enumeration Date | 2015-03-10 |
| Last Update Date | 2021-03-17 |