| NPI | 1831374008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH12846) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NJ 37pc00364400) |
| Enumeration Date | 2008-01-07 |
| Last Update Date | 2017-05-09 |