| NPI | 1649095068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NJ 37AC00712600) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NJ 37AC00712600) |
| Enumeration Date | 2024-11-20 |
| Last Update Date | 2024-11-20 |