| NPI | 1710353396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NJ 37PC00746400) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NJ 37AC00270800) |
| 101YM0800X Counselor, Mental Health (Licence: NY P98733) | |
| Enumeration Date | 2015-08-18 |
| Last Update Date | 2021-01-26 |