| NPI | 1790170611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC A11501) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC 11501) |
| 101YM0800X Counselor, Mental Health (Licence: NJ 37PC01060000) | |
| Enumeration Date | 2015-03-30 |
| Last Update Date | 2025-01-14 |