| NPI | 1003646340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NJ 37PC01041900) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: PA PC017983P) |
| Enumeration Date | 2024-08-02 |
| Last Update Date | 2026-01-07 |