| NPI | 1669832036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701010899) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NJ 37PC00637400) |
| Enumeration Date | 2016-02-29 |
| Last Update Date | 2023-08-22 |