| NPI | 1578883880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NJ 37PC00487500) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH C.0600176) |
| Enumeration Date | 2010-06-09 |
| Last Update Date | 2021-03-19 |