| NPI | 1851943864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NJ 37PC01270400) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| 101YM0800X Counselor, Mental Health (Licence: NJ 37AC00733100) | |
| Enumeration Date | 2019-07-10 |
| Last Update Date | 2026-06-03 |