| NPI | 1720383292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NJ 37PC00402800) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NJ NJ37PC00402800) |
| Enumeration Date | 2011-01-14 |
| Last Update Date | 2022-09-19 |