| NPI | 1780363259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NJ 37PC00963300) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: PA PC015232) |
| Enumeration Date | 2023-07-12 |
| Last Update Date | 2023-07-12 |