| NPI | 1346705894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NJ 37PC00745900) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NJ 37AC00344600) |
| Enumeration Date | 2019-02-08 |
| Last Update Date | 2022-03-04 |