| NPI | 1952939571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: NJ 37PC00882200) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NJ 37AC00493100) |
| Enumeration Date | 2020-03-30 |
| Last Update Date | 2022-09-20 |