| NPI | 1184461741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NJ 37PC00546500) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CT 007663) |
| 101YP2500X Counselor, Professional (Licence: MO 2024042213) | |
| Enumeration Date | 2024-07-11 |
| Last Update Date | 2024-11-12 |