| NPI | 1689716110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NJ 44SC00857600) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NJ 44SC00857600) |
| 101YP1600X Counselor, Pastoral (Licence: NJ 44SC00857600) | |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2007-07-08 |