| NPI | 1639650609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NJ 37PC00755500) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NJ 37AC00432800) |
| Enumeration Date | 2018-08-27 |
| Last Update Date | 2021-12-09 |