NPI | 1740348119 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NJ 37PC00044200) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: PA PC002405) |
Enumeration Date | 2006-12-05 |
Last Update Date | 2007-07-08 |