| NPI | 1275848319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA PC006458) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NJ 37LC00017400) |
| Enumeration Date | 2010-08-13 |
| Last Update Date | 2023-12-22 |