| NPI | 1508487166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NJ 37PC00915500) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: PA PC015566) |
| 101YP2500X Counselor, Professional (Licence: MI 6401225251) | |
| Enumeration Date | 2020-05-05 |
| Last Update Date | 2025-07-15 |