| 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 |