| NPI | 1417582685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA PC009522) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NJ 37PC00528000) |
| Enumeration Date | 2020-03-09 |
| Last Update Date | 2020-03-09 |