| NPI | 1730477415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NJ 37FI00124400) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NJ 6180055) |
| Enumeration Date | 2011-07-15 |
| Last Update Date | 2011-07-15 |