| NPI | 1023795630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA PC010889) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NJ 37PC00732400) |
| Enumeration Date | 2023-07-05 |
| Last Update Date | 2023-07-05 |