| NPI | 1205579166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NJ 37PC00845500) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2022-04-19 |
| Last Update Date | 2023-01-12 |