| 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 |