NPI | 1629501440 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NJ 37PC00668400) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NJ 37AC00347900) |
Enumeration Date | 2017-04-08 |
Last Update Date | 2023-01-20 |