| NPI | 1619599289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 79968) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NJ 37PC00903300) |
| Enumeration Date | 2020-05-17 |
| Last Update Date | 2026-04-27 |