| NPI | 1164183083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NJ 37AC00585500) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NJ 37PC01055600) |
| Enumeration Date | 2022-01-03 |
| Last Update Date | 2026-04-15 |