| NPI | 1811127368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NJ 37PC00445600) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 009218) |
| Enumeration Date | 2009-07-18 |
| Last Update Date | 2023-01-08 |