| NPI | 1609954973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NJ 37PC00281100) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NJ PC003478) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2007-07-08 |