| NPI | 1508412230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NJ 37PC00601400) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CT 004661) |
| Enumeration Date | 2019-08-19 |
| Last Update Date | 2024-04-01 |