| NPI | 1336285733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NJ 37PC00285400) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NY 003217) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2020-05-28 |