NPI | 1982026845 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NJ 37PC00457400) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NJ 37PC00457400) |
Enumeration Date | 2014-01-13 |
Last Update Date | 2025-04-04 |