| NPI | 1083331813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NJ 37PC01155000) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NJ 37AC00533900) |
| Enumeration Date | 2022-10-24 |
| Last Update Date | 2025-06-30 |