| NPI | 1659623809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NJ 37PC00545000) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NJ 37AC0013330) |
| Enumeration Date | 2012-10-12 |
| Last Update Date | 2022-12-26 |