| NPI | 1851977474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NJ 37PC00811100) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NJ 37AC00455100) |
| Enumeration Date | 2021-03-23 |
| Last Update Date | 2025-12-23 |