| NPI | 1053729079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NJ 37PC00568600) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2014-07-23 |
| Last Update Date | 2016-11-01 |