| NPI | 1851943864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NJ 37AC00733100) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2019-07-10 |
| Last Update Date | 2023-08-08 |