| NPI | 1326605023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NJ 37PC00815200) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NJ 37AC00460200) |
| Enumeration Date | 2019-05-29 |
| Last Update Date | 2023-01-17 |