| NPI | 1366118655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NJ 37PC01021000) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: PA PC020223) |
| Enumeration Date | 2021-08-18 |
| Last Update Date | 2026-05-01 |