| NPI | 1164036380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NJ 37PC00727700) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NJ 37PV00727700) |
| 101YP2500X Counselor, Professional (Licence: NV CP5165-R) | |
| Enumeration Date | 2020-09-04 |
| Last Update Date | 2022-07-12 |