| NPI | 1629304043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NJ 37PC00110500) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NJ 37PC00110500) |
| 101YM0800X Counselor, Mental Health (Licence: NJ 37PC00110500) | |
| 101YP2500X Counselor, Professional (Licence: NJ 37PC00110500) | |
| 101YS0200X Counselor, School (Licence: NJ 37PC00110500) | |
| Enumeration Date | 2009-10-19 |
| Last Update Date | 2009-10-19 |