| NPI | 1508615097 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NJ 37AC00620900) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: PA PC016722) |
| Enumeration Date | 2024-05-16 |
| Last Update Date | 2024-06-12 |