NPI | 1750902318 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NJ 37PC00663900) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NJ 37PC00663900) |
Enumeration Date | 2020-05-05 |
Last Update Date | 2025-03-20 |