| NPI | 1619686110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NJ 37PC01006000) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NJ 37ac00534600) |
| Enumeration Date | 2022-11-23 |
| Last Update Date | 2024-02-05 |