| NPI | 1740167360 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NJ 37pc01081900) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: PA pc011098) |
| Enumeration Date | 2025-08-18 |
| Last Update Date | 2025-08-18 |