| NPI | 1215336045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NJ 37PC00527000) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: PA PC007729) |
| Enumeration Date | 2014-08-18 |
| Last Update Date | 2019-03-26 |