| NPI | 1649701285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA PC016381) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NJ 37PC00948000) |
| Enumeration Date | 2017-03-24 |
| Last Update Date | 2025-02-14 |