NPI | 1265067631 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LC12079) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NJ 37PC00809800) |
Enumeration Date | 2020-03-06 |
Last Update Date | 2023-02-28 |