| NPI | 1760868426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NJ 37pc00361500) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NJ 37pc00361500) |
| Enumeration Date | 2015-08-05 |
| Last Update Date | 2015-08-05 |