| NPI | 1962916528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NJ 37PC00900100) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 180011986) |
| 101YM0800X Counselor, Mental Health (Licence: NY 012290) | |
| Enumeration Date | 2017-11-18 |
| Last Update Date | 2023-06-14 |