| NPI | 1174339683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA PC004191) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NJ 37PC01083300) |
| Enumeration Date | 2024-12-09 |
| Last Update Date | 2024-12-09 |